Provider Demographics
NPI:1164426524
Name:KEECH, JOHN A JR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KEECH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 POINT FOSDICK DR NW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1700
Mailing Address - Country:US
Mailing Address - Phone:253-530-8060
Mailing Address - Fax:253-530-8062
Practice Address - Street 1:4545 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 215
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1700
Practice Address - Country:US
Practice Address - Phone:253-530-8060
Practice Address - Fax:253-530-8062
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6222207RH0003X
WAOP60102903207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX62220Medicaid
CA8300001778OtherRAILROAD MEDICARE
WA8558389Medicaid
WA8558389Medicaid